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Jayakumar S, Ahmed AO, Butler PD, Silverstein SM, Thompson JL, Seitz AR. Performance on a contour integration task as a function of contour shape in schizophrenia and controls. Vision Res 2024; 219:108394. [PMID: 38579407 DOI: 10.1016/j.visres.2024.108394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
Contour Integration (CI) is the ability to integrate elemental features into objects and is a basic visual process essential for object perception and recognition, and for functioning in visual environments. It is now well documented that people with schizophrenia (SZ), in addition to having cognitive impairments, also have several visual perceptual deficits, including in CI. Here, we retrospectively characterize the performance of both SZ and neurotypical individuals (NT) on a series of contour shapes, made up of Gabor elements, that varied in terms of closure and curvature. Participants in both groups performed a CI training task that included 7 different families of shapes (Lines, Ellipse, Blobs, Squiggles, Spiral, Circle and Letters) for up to 40 sessions. Two parameters were manipulated in the training task: Orientation Jitter (OJ, i.e., orientation deviations of individual Gabor elements from ideal for each shape) and Inducer Number (IN, i.e., number of Gabor elements defining the shape). Results show that both OJ and IN thresholds significantly differed between the groups, with higher (OJ) and lower (IN) thresholds observed in the controls. Furthermore, we found significant effects as a function of the contour shapes, with differences between groups emerging with contours that were considered more complex, e.g., due to having a higher degree of curvature (Blobs, Spiral, Letters). These data can inform future work that aims to characterize visual integration impairments in schizophrenia.
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Affiliation(s)
- Samyukta Jayakumar
- Department of Psychology, University of California, Riverside, United States.
| | - Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medicine, United States.
| | - Pamela D Butler
- Nathan S. Kline Institute for Psychiatric Research, United States.
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Lu W, Srijeyanthan J, Siriram A, Silverstein SM, Yanos PT, Mueser KT, Gottlieb JD, Marcello S, Kim MJ, Zeiss M. Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care. Early Interv Psychiatry 2024; 18:381-388. [PMID: 38088516 PMCID: PMC11070296 DOI: 10.1111/eip.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 05/07/2024]
Abstract
OBJECTIVES This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care. METHODS Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD. RESULTS Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. CONCLUSION Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.
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Affiliation(s)
- Weili Lu
- Rutgers University, Piscataway, New Jersey, USA
| | | | | | | | - Philip T Yanos
- John Jay College, City University of New York, New York, New York, USA
| | | | - Jennifer D Gottlieb
- Cambridge Health Alliance & Harvard Medical School, Cambridge, Massachusetts, USA
| | | | - Min J Kim
- John Jay College, City University of New York, New York, New York, USA
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3
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Rossi-Goldthorpe R, Silverstein SM, Gold JM, Schiffman J, Waltz JA, Williams TF, Powers AR, Woods SW, Zinbarg RE, Mittal VA, Ellman LM, Strauss GP, Walker EF, Levin JA, Castiello S, Kenney J, Corlett PR. Different learning aberrations relate to delusion-like beliefs with different contents. Brain 2024:awae122. [PMID: 38637303 DOI: 10.1093/brain/awae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/20/2024] Open
Abstract
The prediction error account of delusions has had success. However, its explanation of delusions with different contents has been lacking. Persecutory delusions and paranoia are the common unfounded beliefs that others have harmful intentions towards us. Other delusions include believing that one's thoughts or actions are under external control, or that events in the world have specific personal meaning. We compare learning on two different cognitive tasks, probabilistic reversal learning (PRL) and Kamin blocking, that have relationships to paranoid and non-paranoid delusion-like beliefs, respectively. We find that Clinical High-Risk status alone does not result in different behavioral results on the PRL task but that an individual's level of paranoia is associated with excessive switching behavior. During the Kamin blocking task, paranoid individuals learned inappropriately about the blocked cue. However, they also had decreased learning about the control cue, suggesting more general learning impairments. Non-paranoid delusion-like belief conviction (but not paranoia) was associated with aberrant learning about the blocked cue but intact learning about the control cue, suggesting specific impairments in learning related to cue combination. We fit task-specific computational models separately to behavioral data to explore how latent parameters vary within individuals between tasks, and how they can explain symptom-specific effects. We find that paranoia is associated with low learning rates on the PRL task as well as the blocking task. Non-paranoid delusion-like belief conviction was instead related to parameters controlling the degree and direction of similarity between cue updating during simultaneous cue presentation. These results suggest that paranoia and other delusion-like beliefs involve dissociable deficits in learning and belief updating, which - given the transdiagnostic status of paranoia - may have differential utility in predicting psychosis.
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Affiliation(s)
- Rosa Rossi-Goldthorpe
- Interdepartmental Neuroscience Program, Wu Tsai Institute, Yale University, New Haven, CT 06511, USA
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14623, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY 14623, USA
- Department of Opthalmology, University of Rochester Medical Center, Rochester, NY 14623, USA
| | - James M Gold
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Jason Schiffman
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - James A Waltz
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208-2710, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208-2710, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL 60208-2710, USA
| | | | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA 30322, USA
| | - Jason A Levin
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
| | - Santiago Castiello
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06511, USA
| | - Joshua Kenney
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06511, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06511, USA
- Department of Psychology, Yale University, New Haven, CT 06511, USA
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Boudewyn MA, Erickson MA, Winsler K, Barch DM, Carter CS, Frank MJ, Gold JM, MacDonald AW, Ragland JD, Silverstein SM, Yonelinas AP, Luck SJ. Assessing Trial-by-Trial Electrophysiological and Behavioral Markers of Attentional Control and Sensory Precision in Psychotic and Mood Disorders. Schizophr Bull 2024:sbae038. [PMID: 38616053 DOI: 10.1093/schbul/sbae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS The current study investigated the extent to which changes in attentional control contribute to performance on a visual perceptual discrimination task, on a trial-by-trial basis in a transdiagnostic clinical sample. STUDY DESIGN Participants with schizophrenia (SZ; N = 58), bipolar disorder (N = 42), major depression disorder (N = 51), and psychiatrically healthy controls (N = 92) completed a visual perception task in which stimuli appeared briefly. The design allowed us to estimate the lapse rate and the precision of perceptual representations of the stimuli. Electroencephalograms (EEG) were recorded to examine pre-stimulus activity in the alpha band (8-13 Hz), overall and in relation to behavior performance on the task. STUDY RESULTS We found that the attention lapse rate was elevated in the SZ group compared with all other groups. We also observed group differences in pre-stimulus alpha activity, with control participants showing the highest levels of pre-stimulus alpha when averaging across trials. However, trial-by-trial analyses showed within-participant fluctuations in pre-stimulus alpha activity significantly predicted the likelihood of making an error, in all groups. Interestingly, our analysis demonstrated that aperiodic contributions to the EEG signal (which affect power estimates across frequency bands) serve as a significant predictor of behavior as well. CONCLUSIONS These results confirm the elevated attention lapse rate that has been observed in SZ, validate pre-stimulus EEG markers of attentional control and their use as a predictor of behavior on a trial-by-trial basis, and suggest that aperiodic contributions to the EEG signal are an important target for further research in this area, in addition to alpha-band activity.
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Affiliation(s)
- Megan A Boudewyn
- Department of Psychology, University of California, Santa Cruz, California, USA
| | - Molly A Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Kurt Winsler
- Department of Psychology, University of California, Davis, California, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cameron S Carter
- Department of Psychiatry and Human Behavior, University of California, Irvine, California, USA
| | - Michael J Frank
- Department of Cognitive, Linguistics and Psychological Sciences, Brown University, Providence, Rhode Island, USA
| | - James M Gold
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - J Daniel Ragland
- Department of Psychology, University of California, Davis, California, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Andrew P Yonelinas
- Department of Psychology, University of California, Davis, California, USA
| | - Steven J Luck
- Department of Psychology, University of California, Davis, California, USA
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Culbreth AJ, Moran EK, Mahaphanit W, Erickson MA, Boudewyn MA, Frank MJ, Barch DM, MacDonald AW, Ragland JD, Luck SJ, Silverstein SM, Carter CS, Gold JM. A Transdiagnostic Study of Effort-Cost Decision-Making in Psychotic and Mood Disorders. Schizophr Bull 2024; 50:339-348. [PMID: 37901911 PMCID: PMC10919776 DOI: 10.1093/schbul/sbad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than controls, and thus pursue effortful goals less frequently. This study examined ECDM across psychotic and mood pathology. HYPOTHESIS We hypothesized that patient groups would show reduced willingness to expend effort compared to controls. STUDY DESIGN People with schizophrenia (N = 33), schizoaffective disorder (N = 28), bipolar disorder (N = 39), major depressive disorder (N = 40), and controls (N = 70) completed a physical ECDM task. Participants decided between completing a low-effort or high-effort option for small or larger rewards, respectively. Reward magnitude, reward probability, and effort magnitude varied trial-by-trial. Data were analyzed using standard and hierarchical logistic regression analyses to assess the subject-specific contribution of various factors to choice. Negative symptoms were measured with a clinician-rated interview. STUDY RESULTS There was a significant effect of group, driven by reduced choice of high-effort options in schizophrenia. Hierarchical logistic regression revealed that reduced choice of high-effort options in schizophrenia was driven by weaker contributions of probability information. Use of reward information was inversely associated with motivational impairment in schizophrenia. Surprisingly, individuals with major depressive disorder and bipolar disorder did not differ from controls. CONCLUSIONS Our results provide support for ECDM deficits in schizophrenia. Additionally, differences between groups in ECDM suggest a seemingly similar behavioral phenotype, reduced motivation, could arise from disparate mechanisms.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
| | - Erin K Moran
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
| | - Wasita Mahaphanit
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, USA
| | - Molly A Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Megan A Boudewyn
- Department of Psychology, University of California, Santa Cruz, USA
| | - Michael J Frank
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, USA
| | | | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - Steven J Luck
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
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Thakkar KN, Silverstein SM, Fattal J, Bao J, Slate R, Roberts D, Brascamp JW. Stronger tilt aftereffects in individuals diagnosed with schizophrenia spectrum disorders but not bipolar disorder. Schizophr Res 2024; 264:345-353. [PMID: 38218020 PMCID: PMC10923089 DOI: 10.1016/j.schres.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 01/15/2024]
Abstract
An altered use of context and experience to interpret incoming information has been posited to explain schizophrenia symptoms. The visual system can serve as a model system for examining how context and experience guide perception and the neural mechanisms underlying putative alterations. The influence of prior experience on current perception is evident in visual aftereffects, the perception of the "opposite" of a previously viewed stimulus. Aftereffects are associated with neural adaptation and concomitant change in strength of lateral inhibitory connections in visually responsive neurons. In a previous study, we observed stronger aftereffects related to orientation (tilt aftereffects) but not luminance (negative afterimages) in individuals diagnosed with schizophrenia, which we interpreted as potentially suggesting altered cortical (but not subcortical) adaptability and local changes in excitatory-inhibitory interactions. Here, we tested whether stronger tilt aftereffects were specific to individuals with schizophrenia or extended to individuals with bipolar disorder. We measured tilt aftereffects and negative afterimages in 32 individuals with bipolar disorder, and compared aftereffect strength to a previously reported group of 36 individuals with schizophrenia and 22 healthy controls. We observed stronger tilt aftereffects, but not negative afterimages, in individuals with schizophrenia as compared to both controls and individuals with bipolar disorder, who did not differ from each other. These results mitigate concerns that stronger tilt aftereffects in schizophrenia are a consequence of medication or of the psychosocial consequences of a severe mental illness.
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Affiliation(s)
- Katharine N Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America; Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, United States of America.
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Jessica Fattal
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Jacqueline Bao
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America; Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
| | - Rachael Slate
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Dominic Roberts
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Jan W Brascamp
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
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Krukow P, Domagała A, Silverstein SM. Specific association between retinal neural layer thinning and neurological soft signs in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01742-3. [PMID: 38244078 DOI: 10.1007/s00406-023-01742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Abstract
There is growing evidence of disproportionate retinal thinning in schizophrenia, but doubts are still raised regarding its significance in the context of the neurobiology of the disease. Therefore, we examined whether these abnormalities are significantly associated with neurological soft signs (NSS) which are closely related to the risk of schizophrenia. This cross-sectional study analyzing linear correlations between variables involved 56 schizophrenia inpatients and 60 controls. The results confirmed such relationships, and only in the patient sample. In addition, retinal abnormalities and NSS were significantly correlated with duration of illness. These findings provide further evidence for linked neurodevelopmental and neurodegenerative aspects of schizophrenia.
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Affiliation(s)
- Paweł Krukow
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland.
| | - Adam Domagała
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Boudewyn MA, Erickson MA, Winsler K, Ragland JD, Yonelinas A, Frank M, Silverstein SM, Gold J, MacDonald AW, Carter CS, Barch DM, Luck SJ. Managing EEG studies: How to prepare and what to do once data collection has begun. Psychophysiology 2023; 60:e14365. [PMID: 37314113 DOI: 10.1111/psyp.14365] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023]
Abstract
In this paper, we provide guidance for the organization and implementation of EEG studies. This work was inspired by our experience conducting a large-scale, multi-site study, but many elements could be applied to any EEG project. Section 1 focuses on study activities that take place before data collection begins. Topics covered include: establishing and training study teams, considerations for task design and piloting, setting up equipment and software, development of formal protocol documents, and planning communication strategy with all study team members. Section 2 focuses on what to do once data collection has already begun. Topics covered include: (1) how to effectively monitor and maintain EEG data quality, (2) how to ensure consistent implementation of experimental protocols, and (3) how to develop rigorous preprocessing procedures that are feasible for use in a large-scale study. Links to resources are also provided, including sample protocols, sample equipment and software tracking forms, sample code, and tutorial videos (to access resources, please visit: https://osf.io/wdrj3/).
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Affiliation(s)
- Megan A Boudewyn
- Department of Psychology, University of California Santa Cruz, Santa Cruz, California, USA
| | - Molly A Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Kurt Winsler
- Department of Psychology, University of California, Davis, California, USA
| | - John Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Andrew Yonelinas
- Department of Psychology, University of California, Davis, California, USA
| | - Michael Frank
- Department of Cognitive, Linguistics and Psychological Sciences, Brown University, Providence, Rhode Island, USA
| | - Steven M Silverstein
- Department of Psychiatry, Neuroscience and Opthamology, University of Rochester, Rochester Medical Center, Rochester, New York, USA
| | - Jim Gold
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Steven J Luck
- Department of Psychology, University of California, Davis, California, USA
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Fattal J, Mittal VA, Silverstein SM. Closed eye hallucinations in psychotic disorders. Schizophr Res 2023; 260:65-66. [PMID: 37625225 DOI: 10.1016/j.schres.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/22/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Jessica Fattal
- Department of Psychology, Northwestern University, Evanston, IL, United States of America.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States of America
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
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10
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Dalloul N, Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning. Schizophr Bull 2023; 49:1281-1293. [PMID: 37382553 PMCID: PMC10483466 DOI: 10.1093/schbul/sbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND HYPOTHESIS Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. STUDY DESIGN Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). RESULTS Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. CONCLUSIONS These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
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Affiliation(s)
- Nada Dalloul
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, CA, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, CA, USA
| | | | - Steven J Luck
- Department of Psychology, University of California, Davis, CA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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11
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Abstract
BACKGROUND AND HYPOTHESES Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more strongly related to age in schizophrenia and schizoaffective disorder patients (SZ) than in a psychiatrically healthy control group (CON). STUDY DESIGN Schizophrenia (n = 60) and CON participants (n = 69) underwent spectral domain optical coherence tomography (OCT) scans to examine the following variables in both eyes: retinal nerve fiber layer (RNFL) thickness, macula central subfield (CSF) thickness, macula volume, ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, optic cup volume, and cup-to-disc ratio. Eleven participants in each group had diabetes or hypertension. STUDY RESULTS Significant negative relationships between age and RNFL thickness, macula volume, and GCL-IPL thickness were observed in the SZ group, while no significant relationships were observed in the CON group. However, many of the findings in the SZ group lost significance when participants with diabetes/hypertension were removed from analyses. A notable exception to this was that the age × SZ interaction accounted for a unique proportion of variance in GCL-IPL thinning over and above the effect of diabetes/hypertension. CONCLUSIONS The results suggest that retinal atrophy occurs at an increased rate in schizophrenia spectrum disorders, potentially reflecting accelerated aging inherent to these conditions, with considerable contributions from systemic medical diseases closely linked to this population.
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Affiliation(s)
- Brittany A Blose
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Judy L Thompson
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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12
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Affiliation(s)
- Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Aubrey C Chan
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Susan Padrino
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
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13
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Lu W, Mueser KT, Yanos PT, Siriram A, Jia Y, Leong A, Silverstein SM, Gottlieb J, Jankowski MK. Post-Traumatic Cognitions Inventory (PTCI): psychometric properties in clients with serious mental illness and co-occurring PTSD. Behav Cogn Psychother 2023; 51:459-474. [PMID: 37212149 DOI: 10.1017/s1352465823000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND People with post-traumatic stress disorder (PTSD) exhibit negative cognitions, predictive of PTSD severity. The Post-Traumatic Cognitions Inventory (PTCI) is a widely used instrument measuring trauma-related cognitions and beliefs with three subscales: negative thoughts of self (SELF), negative cognitions about the world (WORLD), and self-blame (BLAME). AIMS The current study attempted to validate the use of the PTCI in people with serious mental illness (SMI), who have greater exposure to trauma and elevated rates of PTSD, using confirmatory factor analysis (CFA) and examining convergent and divergent correlations with relevant constructs. METHOD Participants were 432 individuals with SMI and co-occurring PTSD diagnosis based on the Clinician Administered PTSD Scale, who completed PTCI and other clinical ratings. RESULTS CFAs provided adequate support for Foa's three-factor model (SELF, WORLD, BLAME), and adequate support for Sexton's four-factor model that also included a COPE subscale. Both models achieved measurement invariance at configural, metric and scalar levels for three diagnostic groups: schizophrenia, bipolar and major depression, as well as for ethnicity (White vs Black), and gender (male vs female). Validity of both models was supported by significant correlations between PTCI subscales, and self-reported and clinician assessed PTSD symptoms and associated symptoms. CONCLUSIONS Findings provide support for the psychometric properties of the PTCI and the conceptualization of Sexton's four-factor and Foa's three-factor models of PTCI among individuals diagnosed with SMI (Foa et al., ).
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Affiliation(s)
- Weili Lu
- Rutgers University, New Brunswick, USA
| | | | | | | | - Yuane Jia
- Rutgers University, New Brunswick, USA
| | | | | | | | - Mary K Jankowski
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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14
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Fradkin SI, Bannai D, Lizano P, Lai A, Crosta C, Silverstein SM. Poster Session: Deep retinal layer microvasculature alterations in first episode and chronic schizophrenia. J Vis 2023; 23:50. [PMID: 37733528 DOI: 10.1167/jov.23.11.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
People with schizophrenia (SZ) demonstrate retinal microvasculature alterations that are similar to those observed in individuals with neurodegenerative disorders. Initial findings indicate that these changes are present in the superficial layer in SZ. This study examined whether changes are also present in the deep retinal layer level (DRL). Twenty-six individuals with SZ (10 with first episode psychosis [FEP]) and 37 healthy controls (HCs; 17 age-matched to FEP group) completed optical coherence tomography angiography scans. Compared to controls, people with SZ demonstrated reduced DRL perfusion density (ps < 0.04) and vessel diameter (ps < 0.01) in both eyes, and, in the left eye only, reduced vessel length and fractal dimension (ps = 0.01). We then tested for an illness progression effect by determining the degree to which the original 4 group means were characterized by a polynomial (linear) trend, using the following contrast coefficients: non-FEP SZ (-2), FEP (0), older controls (0), young controls (2). The hypothesized pattern was observed to a significant or trend level degree for 7 out of 8 variables, with effect sizes ranging from small to large. Findings also indicated that, within the SZ group, reduced DRL perfusion density and vessel length were associated with reductions in (previously reported) superficial layer indices (ps < .001). Overall, findings suggest that alterations in retinal microvasculature are present in both the superficial and DRL in SZ.
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Affiliation(s)
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Adriann Lai
- Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, & Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
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15
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Silverstein SM. Invited Session V: The eye as a window to systemic and neurodegenerative health: Disturbances of retinal structure in schizophrenia spectrum disorders and their clinical implications. J Vis 2023; 23:28. [PMID: 37733550 DOI: 10.1167/jov.23.11.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Schizophrenia (SZ) is a disabling psychiatric condition that is characterized by disturbances in reality testing (e.g., hallucinations, delusions) during its acute phase and by many brain-related impairments. It has become apparent, however, that the CNS disturbance in SZ extends to the retina. Studies have demonstrated retinal structural (neural and vascular) and functional (e.g., ERG) changes in SZ, although findings vary in effect size and confounds are often present. This presentation will review several studies from my lab that used OCT and OCTA to investigate retinal characteristics of people with SZ, with a focus on characterizing within-group heterogeneity. Results indicate that: 1) retinal thinning is present at the macula, but not until several years after the first psychotic episode; 2) reductions in microvasculature density are observable as early as the first episode and worsen over time at a greater rate than expected by age alone; 3) microvasculature reductions are present in both the superficial and deep retinal layers; and 4) issues such as diabetes, smoking, and obesity must be carefully considered when studying the retina in SZ. Findings will be discussed within the context of the emerging view that SZ is multi-system disorder with a significant vascular-ischemic component.
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Affiliation(s)
- Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester
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16
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Silverstein SM, Sato MA, Meier EJ, Dai S, Bauskar A, Depperschmidt K, Blender N, Vantipalli S, Goldstein MH, Gurses Ozden R. Effects of Punctal Occlusion on Ocular Itching and Conjunctival Redness Associated with Allergic Conjunctivitis. Curr Eye Res 2023; 48:781-787. [PMID: 37199292 DOI: 10.1080/02713683.2023.2211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Punctal occlusion using punctal plugs has been successfully used to treat the signs and symptoms of dry eye disease. However, the effects of punctal occlusion on the symptoms of allergic conjunctivitis (AC) have been less well documented. There is some concern among clinicians that punctal occlusion may make signs/symptoms of allergic conjunctivitis worse by trapping allergens on the eye. The objective of this post hoc analysis was to address this question and thus assess the effect of punctal occlusion alone on ocular itching and conjunctival redness associated with AC. METHODS This was a pooled post hoc analysis of three randomized, double-blind, placebo insert-controlled clinical trials in subjects with AC. Enrolled subjects were generally healthy adults with ocular allergies and a positive skin test reaction to perennial and/or seasonal allergens. The study used a modified version of the traditional conjunctival allergen challenge (CAC) model, which included multiple, repeated allergen challenges following placement of the intracanalicular insert. Subjects were rechallenged on Days 6, 7 and 8; Days 13, 14 and 15; and Days 26, 27 and 28. RESULTS The data set included 128 subjects that were administered placebo. Baseline mean (SD) ocular itching and conjunctival redness scores were 3.52 (0.44) and 2.97 (0.39), respectively. On post-insertion Days 7, 14 and 28, mean itching scores were 2.62, 2.26 and 1.91, respectively, representing 26%, 36% and 46% itching reductions, respectively (p < 0.001). On Days 7, 14 and 28, mean conjunctival redness scores were 1.98, 1.90, and 2.08, respectively, representing 33%, 36%, and 30% redness reductions, respectively (p < 0.001). CONCLUSIONS Based on this post hoc pooled analysis, punctal occlusion with a resorbable hydrogel intracanalicular insert did not worsen ocular itching or conjunctival redness in this patient population.
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Affiliation(s)
| | | | | | - Stella Dai
- Ocular Therapeutix, Inc., Bedford, MA, USA
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17
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Williams TF, Walker EF, Strauss GP, Woods SW, Powers AR, Corlett PR, Schiffman J, Waltz JA, Gold JM, Silverstein SM, Ellman LM, Zinbarg RE, Mittal VA. The reliability and validity of the revised Green et al. paranoid thoughts scale in individuals at clinical high-risk for psychosis. Acta Psychiatr Scand 2023; 147:623-633. [PMID: 36905387 PMCID: PMC10463775 DOI: 10.1111/acps.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Paranoia is a common and impairing psychosis symptom, which exists along a severity continuum that extends into the general population. Individuals at clinical high-risk for psychosis (CHR) frequently experience paranoia and this may elevate their risk for developing full psychosis. Nonetheless, limited work has examined the efficient measurement of paranoia in CHR individuals. The present study aimed to validate an often-used self-report measure, the revised green paranoid thoughts scale (RGPTS), in this critical population. METHOD Participants were CHR individuals (n = 103), mixed clinical controls (n = 80), and healthy controls (n = 71) who completed self-report and interview measures. Confirmatory factor analysis (CFA), psychometric indices, group differences, and relations to external measures were used to evaluate the reliability and validity of the RGPTS. RESULTS CFA replicated a two-factor structure for the RGPTS and the associated reference and persecution scales were reliable. CHR individuals scored significantly higher on both reference and persecution, relative to both healthy (ds = 1.03, 0.86) and clinical controls (ds = 0.64, 0.73). In CHR participants, correlations between reference and persecution and external measures were smaller than expected, though showed evidence of discriminant validity (e.g., interviewer-rated paranoia, r = 0.24). When examined in the full sample, correlation magnitude was larger and follow-up analyses indicated that reference related most specifically to paranoia (β = 0.32), whereas persecution uniquely related to poor social functioning (β = -0.29). CONCLUSION These results demonstrate the reliability and validity of the RGPTS, though its scales related more weakly to severity in CHR individuals. The RGPTS may be useful in future work aiming to develop symptom-specific models of emerging paranoia in CHR individuals.
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Affiliation(s)
- Trevor F. Williams
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, 30322, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, 30602, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Philip R. Corlett
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA, 92697, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - Steven M. Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Lauren M. Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, 19122, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, 60208, USA
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18
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Karp EL, Williams TF, Ellman LM, Strauss GP, Walker EF, Corlett PR, Woods SW, Powers AR, Gold JM, Schiffman JE, Waltz JA, Silverstein SM, Mittal VA. Self-reported Gesture Interpretation and Performance Deficits in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:746-755. [PMID: 36939086 PMCID: PMC10154698 DOI: 10.1093/schbul/sbac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Deficits in performing and interpreting communicative nonverbal behaviors, such as gesture, have been linked to varied psychopathology and dysfunction. Some evidence suggests that individuals at risk for psychosis have deficits in gesture interpretation and performance; however, individuals with internalizing disorders (eg, depression) may have similar deficits. No previous studies have examined whether gesture deficits in performance and interpretation are specific to those at risk for psychosis. Additionally, the underlying mechanisms (eg, cognition) and consequences (eg, functioning) of these deficits are poorly understood. STUDY DESIGN This study examined self-reported gesture interpretation (SRGI) and performance (SRGP) in those at clinical high risk for psychosis (CHR; N = 88), those with internalizing disorders (INT; N = 51), and healthy controls (HC; N = 53). Participants completed questionnaires, clinical interviews, and neurocognitive tasks. STUDY RESULTS Results indicated that the CHR group was characterized by significantly lower SRGI scores than the HC or INT groups (d = 0.41); there were no differences among groups in SRGP. Within CHR participants, greater deficits in SRGP were associated with lower verbal learning and memory (r = -.33), but not general intelligence or processing speed. Furthermore, gesture deficits were associated with higher cross-sectional risk for conversion to a full psychotic disorder in the CHR group. CONCLUSIONS Overall, these findings suggest that specific subdomains of gesture may reflect unique vulnerability for psychosis, self-report may be a viable assessment tool in understanding these phenomena, and gesture dysfunction may signal risk for transition to psychosis.
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Affiliation(s)
- Erica L Karp
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Jason E Schiffman
- Department of Psychological Science, University of California, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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Wagner SK, Cortina-Borja M, Silverstein SM, Zhou Y, Romero-Bascones D, Struyven RR, Trucco E, Mookiah MRK, MacGillivray T, Hogg S, Liu T, Williamson DJ, Pontikos N, Patel PJ, Balaskas K, Alexander DC, Stuart KV, Khawaja AP, Denniston AK, Rahi JS, Petzold A, Keane PA. Association Between Retinal Features From Multimodal Imaging and Schizophrenia. JAMA Psychiatry 2023; 80:478-487. [PMID: 36947045 PMCID: PMC10034669 DOI: 10.1001/jamapsychiatry.2023.0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Abstract
Importance The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population. Design, Setting, and Participants This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022. Main Outcomes and Measures Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers. Results A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (-4.05 μm, 95% CI, -5.40 to -2.69; P = 5.4 × 10-9), which persisted when investigating only patients without diabetes (-3.99 μm; 95% CI, -6.67 to -1.30; P = .004) or just those 55 years and younger (-2.90 μm; 95% CI, -5.55 to -0.24; P = .03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (-0.14 units; 95% CI, -0.22 to -0.05; P = .001), although this was not present when excluding patients with diabetes. Conclusions and Relevance In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation.
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Affiliation(s)
- Siegfried K. Wagner
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Steven M. Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
- Center for Visual Science, University of Rochester, Rochester, New York
| | - Yukun Zhou
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - David Romero-Bascones
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Robbert R. Struyven
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Emanuele Trucco
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Muthu R. K. Mookiah
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Hogg
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Timing Liu
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dominic J. Williamson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Praveen J. Patel
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Kelsey V. Stuart
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair K. Denniston
- University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Jugnoo S. Rahi
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Axel Petzold
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Pearse A. Keane
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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20
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Shoham N, Lewis G, Hayes JF, Silverstein SM, Cooper C. Association between visual impairment and psychosis: A longitudinal study and nested case-control study of adults. Schizophr Res 2023; 254:81-89. [PMID: 36805651 DOI: 10.1016/j.schres.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Theories propose that visual impairment might increase the risk of psychosis, and vice versa. We aimed to investigate the relationship between visual impairment and psychosis in the UK Biobank cohort. STUDY DESIGN In a nested case control study of ~116,000 adults, we tested whether a Schizophrenia Spectrum Disorder (SSD) diagnosis as exposure was associated with visual impairment. We also tested longitudinally whether poorer visual acuity, and thinner retinal structures on Optical Coherence Tomography (OCT) scans in 2009 were associated with psychotic experiences in 2016. We adjusted for age, sex, depression and anxiety symptoms; and socioeconomic variables and vascular risk factors where appropriate. We compared complete case with multiple imputation models, designed to reduce bias potentially introduced by missing data. RESULTS People with visual impairment had greater odds of SSD than controls in multiply imputed data (Adjusted Odds Ratio [AOR] 1.42, 95 % Confidence Interval [CI] 1.05-1.93, p = 0.021). We also found evidence that poorer visual acuity was associated with psychotic experiences during follow-up (AOR per 0.1 point worse visual acuity score 1.06, 95 % CI 1.01-1.11, p = 0.020; and 1.04, 95 % CI 1.00-1.08, p = 0.037 in right and left eye respectively). In complete case data (15 % of this cohort) we found no clear association, although confidence intervals included the multiple imputation effect estimates. OCT measures were not associated with psychotic experiences. CONCLUSIONS Our findings highlight the importance of eye care for people with psychotic illnesses. We could not conclude whether visual impairment is a likely causal risk factor for psychosis.
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Affiliation(s)
- Natalie Shoham
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
| | - Gemma Lewis
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F Hayes
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK
| | - Steven M Silverstein
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Claudia Cooper
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AD, UK; East London NHS Foundation Trust, UK
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21
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Keane BP, Krekelberg B, Mill RD, Silverstein SM, Thompson JL, Serody MR, Barch DM, Cole MW. Dorsal attention network activity during perceptual organization is distinct in schizophrenia and predictive of cognitive disorganization. Eur J Neurosci 2023; 57:458-478. [PMID: 36504464 DOI: 10.1111/ejn.15889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Visual shape completion is a canonical perceptual organization process that integrates spatially distributed edge information into unified representations of objects. People with schizophrenia show difficulty in discriminating completed shapes, but the brain networks and functional connections underlying this perceptual difference remain poorly understood. Also unclear is whether brain network differences in schizophrenia occur in related illnesses or vary with illness features transdiagnostically. To address these topics, we scanned (functional magnetic resonance imaging, fMRI) people with schizophrenia, bipolar disorder, or no psychiatric illness during rest and during a task in which they discriminated configurations that formed or failed to form completed shapes (illusory and fragmented condition, respectively). Multivariate pattern differences were identified on the cortical surface using 360 predefined parcels and 12 functional networks composed of such parcels. Brain activity flow mapping was used to evaluate the likely involvement of resting-state connections for shape completion. Illusory/fragmented task activation differences ('modulations') in the dorsal attention network (DAN) could distinguish people with schizophrenia from the other groups (AUCs > .85) and could transdiagnostically predict cognitive disorganization severity. Activity flow over functional connections from the DAN could predict secondary visual network modulations in each group, except in schizophrenia. The secondary visual network was strongly and similarly modulated in each group. Task modulations were dispersed over more networks in patients compared to controls. In summary, DAN activity during visual perceptual organization is distinct in schizophrenia, symptomatically relevant, and potentially related to improper attention-related feedback into secondary visual areas.
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Affiliation(s)
- Brian P Keane
- University Behavioral Health Care, Department of Psychiatry, and Center for Cognitive Science, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
| | - Bart Krekelberg
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Ravi D Mill
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Steven M Silverstein
- University Behavioral Health Care, Department of Psychiatry, and Center for Cognitive Science, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA
| | - Judy L Thompson
- Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Megan R Serody
- University Behavioral Health Care, Department of Psychiatry, and Center for Cognitive Science, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
| | - Deanna M Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael W Cole
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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22
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Pratt DN, Luther L, Kinney KS, Osborne KJ, Corlett PR, Powers AR, Woods SW, Gold JM, Schiffman J, Ellman LM, Strauss GP, Walker EF, Zinbarg R, Waltz JA, Silverstein SM, Mittal VA. Comparing a Computerized Digit Symbol Test to a Pen-and-Paper Classic. Schizophr Bull Open 2023; 4:sgad027. [PMID: 37868160 PMCID: PMC10590153 DOI: 10.1093/schizbullopen/sgad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background and Hypothesis Processing speed dysfunction is a core feature of psychosis and predictive of conversion in individuals at clinical high risk (CHR) for psychosis. Although traditionally measured with pen-and-paper tasks, computerized digit symbol tasks are needed to meet the increasing demand for remote assessments. Therefore we: (1) assessed the relationship between traditional and computerized processing speed measurements; (2) compared effect sizes of impairment for progressive and persistent subgroups of CHR individuals on these tasks; and (3) explored causes contributing to task performance differences. Study Design Participants included 92 CHR individuals and 60 healthy controls who completed clinical interviews, the Brief Assessment of Cognition in Schizophrenia Symbol Coding test, the computerized TestMyBrain Digit Symbol Matching Test, a finger-tapping task, and a self-reported motor abilities measure. Correlations, Hedges' g, and linear models were utilized, respectively, to achieve the above aims. Study Results Task performance was strongly correlated (r = 0.505). A similar degree of impairment was seen between progressive (g = -0.541) and persistent (g = -0.417) groups on the paper version. The computerized task uniquely identified impairment for progressive individuals (g = -477), as the persistent group performed similarly to controls (g = -0.184). Motor abilities were related to the computerized version, but the paper version was more related to symptoms and psychosis risk level. Conclusions The paper symbol coding task measures impairment throughout the CHR state, while the computerized version only identifies impairment in those with worsening symptomatology. These results may be reflective of sensitivity differences, an artifact of existing subgroups, or evidence of mechanistic differences.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Kyle S Kinney
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | | | | | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA
- Department of Neuroscience, University of Georgia, Athens, GA, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - James A Waltz
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA
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23
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Choi J, Byju AS, Ramchandran R, Alexis JD, Gupta A, Rubens D, Lee HB, Silverstein SM. Retinal Biomarkers as Indicators for Cognitive Impairment and Depression. J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.10.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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24
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Geana A, Barch DM, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Frank MJ. Using Computational Modeling to Capture Schizophrenia-Specific Reinforcement Learning Differences and Their Implications on Patient Classification. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:1035-1046. [PMID: 33878489 PMCID: PMC9272137 DOI: 10.1016/j.bpsc.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychiatric diagnosis and treatment have historically taken a symptom-based approach, with less attention on identifying underlying symptom-producing mechanisms. Recent efforts have illuminated the extent to which different underlying circuitry can produce phenotypically similar symptomatology (e.g., psychosis in bipolar disorder vs. schizophrenia). Computational modeling makes it possible to identify and mathematically differentiate behaviorally unobservable, specific reinforcement learning differences in patients with schizophrenia versus other disorders, likely owing to a higher reliance on prediction error-driven learning associated with basal ganglia and underreliance on explicit value representations associated with orbitofrontal cortex. METHODS We used a well-established probabilistic reinforcement learning task to replicate those findings in individuals with schizophrenia both on (n = 120) and off (n = 44) antipsychotic medications and included a patient comparison group of bipolar patients with psychosis (n = 60) and healthy control subjects (n = 72). RESULTS Using accuracy, there was a main effect of group (F3,279 = 7.87, p < .001), such that all patient groups were less accurate than control subjects. Using computationally derived parameters, both medicated and unmediated individuals with schizophrenia, but not patients with bipolar disorder, demonstrated a reduced mixing parameter (F3,295 = 13.91, p < .001), indicating less dependence on learning explicit value representations as well as greater learning decay between training and test (F1,289 = 12.81, p < .001). Unmedicated patients with schizophrenia also showed greater decision noise (F3,295 = 2.67, p = .04). CONCLUSIONS Both medicated and unmedicated patients showed overreliance on prediction error-driven learning as well as significantly higher noise and value-related memory decay, compared with the healthy control subjects and the patients with bipolar disorder. Additionally, the computational model parameters capturing these processes can significantly improve patient/control classification, potentially providing useful diagnosis insight.
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Affiliation(s)
- Andra Geana
- Department of Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island.
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, Maryland
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, California
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, California
| | | | - Michael J Frank
- Department of Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island
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25
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Barch DM, Boudewyn MA, Carter CC, Erickson M, Frank MJ, Gold JM, Luck SJ, MacDonald AW, Ragland JD, Ranganath C, Silverstein SM, Yonelinas A. Cognitive [Computational] Neuroscience Test Reliability and Clinical Applications for Serious Mental Illness (CNTRaCS) Consortium: Progress and Future Directions. Curr Top Behav Neurosci 2022; 63:19-60. [PMID: 36173600 DOI: 10.1007/7854_2022_391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The development of treatments for impaired cognition in schizophrenia has been characterized as the most important challenge facing psychiatry at the beginning of the twenty-first century. The Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) project was designed to build on the potential benefits of using tasks and tools from cognitive neuroscience to better understanding and treat cognitive impairments in psychosis. These benefits include: (1) the use of fine-grained tasks that measure discrete cognitive processes; (2) the ability to design tasks that distinguish between specific cognitive domain deficits and poor performance due to generalized deficits resulting from sedation, low motivation, poor test taking skills, etc.; and (3) the ability to link cognitive deficits to specific neural systems, using animal models, neuropsychology, and functional imaging. CNTRICS convened a series of meetings to identify paradigms from cognitive neuroscience that maximize these benefits and identified the steps need for translation into use in clinical populations. The Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRaCS) Consortium was developed to help carry out these steps. CNTRaCS consists of investigators at five different sites across the country with diverse expertise relevant to a wide range of the cognitive systems identified as critical as part of CNTRICs. This work reports on the progress and current directions in the evaluation and optimization carried out by CNTRaCS of the tasks identified as part of the original CNTRICs process, as well as subsequent extensions into the Positive Valence systems domain of Research Domain Criteria (RDoC). We also describe the current focus of CNTRaCS, which involves taking a computational psychiatry approach to measuring cognitive and motivational function across the spectrum of psychosis. Specifically, the current iteration of CNTRaCS is using computational modeling to isolate parameters reflecting potentially more specific cognitive and visual processes that may provide greater interpretability in understanding shared and distinct impairments across psychiatric disorders.
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Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | | | | | | | | | - James M Gold
- Maryland Psychiatric Research Center, Baltimore, MD, USA
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26
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Abstract
The field of psychiatry is far from perfect in predicting which individuals will transition to a psychotic disorder. Here, we argue that visual system assessment can help in this regard. Such assessments have generated medium-to-large group differences with individuals prior to or near the first psychotic episode or have shown little influence of illness duration in larger samples of more chronic patients. For example, self-reported visual perceptual distortions-so-called visual basic symptoms-occur in up to 2/3rds of those with non-affective psychosis and have already longitudinally predicted an impending onset of schizophrenia. Possibly predictive psychophysical markers include enhanced contrast sensitivity, prolonged backward masking, muted collinear facilitation, reduced stereoscopic depth perception, impaired contour and shape integration, and spatially restricted exploratory eye movements. Promising brain-based markers include visual thalamo-cortical hyperconnectivity, decreased occipital gamma band power during visual detection (MEG), and reduced visually evoked occipital P1 amplitudes (EEG). Potentially predictive retinal markers include diminished cone a- and b-wave amplitudes and an attenuated photopic flicker response during electroretinography. The foregoing assessments are often well-described mechanistically, implying that their findings could readily shed light on the underlying pathophysiological changes that precede or accompany a transition to psychosis. The retinal and psychophysical assessments in particular are inexpensive, well-tolerated, easy to administer, and brief, with few inclusion/exclusion criteria. Therefore, across all major levels of analysis-from phenomenology to behavior to brain and retinal functioning-visual system assessment could complement and improve upon existing methods for predicting which individuals go on to develop a psychotic disorder.
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Affiliation(s)
- Alexander Diamond
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
- Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
| | - Brian P Keane
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA.
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA.
- Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA.
- Department of Brain & Cognitive Sciences, University of Rochester, 358 Meliora Hall, NY, Rochester, USA.
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27
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Demmin DL, Silverstein SM, Shors TJ. Mental and physical training with meditation and aerobic exercise improved mental health and well-being in teachers during the COVID-19 pandemic. Front Hum Neurosci 2022; 16:847301. [PMID: 36082230 PMCID: PMC9446448 DOI: 10.3389/fnhum.2022.847301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Teachers face significant stressors in relation to their work, placing them at increased risk for burnout and attrition. The COVID-19 pandemic has brought about additional challenges, resulting in an even greater burden. Thus, strategies for reducing stress that can be delivered virtually are likely to benefit this population. Mental and Physical (MAP) Training combines meditation with aerobic exercise and has resulted in positive mental and physical health outcomes in both clinical and subclinical populations. The aim of this pilot study was to evaluate the feasibility and potential effectiveness of virtual MAP Training on reducing stress and improving mood and well-being in teachers. Participants (n = 104) were from recruited online from kindergarten to grade twelve (K-12) schools in the Northeastern region of the United States and randomly assigned to a 6-week program of virtual MAP Training (n = 58) or no training (n = 13). Primary outcomes included pre-intervention and post-intervention ratings on self-report measures of social and emotional health. Changes in cognitive functioning and physical health were also examined in secondary analyses. By intervention end, participants in the MAP Training group reported less anxiety and work-related stress compared to those who received no training (ds = −0.75 to −0.78). Additionally, MAP Training participants reported improvements in depressive symptoms, rumination, work-related quality of life, perceived stress, and self-compassion (ds = 0.38 to −0.82), whereas no changes were observed in the no training group. Participants also reported increased subjective ratings of executive functioning, working memory, cognitive flexibility, and fewer sleep disturbances (ds = −0.41 to −0.74). Together, these results suggest that the combination of meditation and aerobic exercise is an effective virtual intervention for improving mental health and well-being among K-12 teachers and may enhance resilience to stressful life events such as occurred during the coronavirus pandemic.
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Affiliation(s)
- Docia L. Demmin
- Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, United States
- *Correspondence: Docia L. Demmin,
| | - Steven M. Silverstein
- Department of Psychiatry, Rutgers University, Piscataway, NJ, United States
- Department of Neuroscience and Ophthalmology, University of Rochester, Rochester, NY, United States
| | - Tracey J. Shors
- Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, United States
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28
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Lu W, Silverstein SM, Mueser KT, Minsky S, Bullock D, Buchbinder S, Chen Q, Eubanks R, Guillaume-Salvant A. Undocumented PTSD among African American clients with serious mental illness in a statewide mental health system. Psychol Trauma 2022:2022-79121-001. [PMID: 35797171 PMCID: PMC10229093 DOI: 10.1037/tra0001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES African Americans are at increased risk for trauma exposure and the development of posttraumatic stress disorder (PTSD) relative to other racial groups. Among African Americans with Serious Mental Illness (SMI), PTSD is frequently underdiagnosed and untreated. The primary objective of this study was to investigate trauma exposure, PTSD symptom severity, and the rate of undocumented PTSD in medical records among African Americans diagnosed with SMI. METHODS Screening for trauma exposure and PTSD symptoms was implemented among 404 clients receiving community mental health services. Participants endorsed at least 1 traumatic event, had a score of at least 45 on the DSM-IV PTSD Checklist indicating probable PTSD, and had a chart diagnosis of an Axis I disorder. RESULTS Around 18.3% of participants had PTSD diagnosed in their medical chart. A diagnosis of schizophrenia/schizoaffective disorder was inversely related to the detection of PTSD in the chart. Client age and gender did not adversely affect the detection of PTSD, and detection rates remained low overall. Childhood sexual abuse was the most commonly endorsed index trauma, followed closely by sudden death of a loved one (including violent death). Participants typically experienced an average of 8 types of traumatic events in their lifetime. Cumulative total trauma exposure significantly predicted PTSD severity. Clients with mood disorders reported more severe PTSD. CONCLUSION Findings highlight the low detection rate of PTSD and related symptoms in African American clients with SMI. There is a need for early intervention, grief counseling, culturally sensitive trauma screening, and culturally informed treatment options for this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions
| | | | | | - Shula Minsky
- Department of Psychiatric Rehabilitation and Counseling Professions
| | - Deanna Bullock
- Department of Psychiatric Rehabilitation and Counseling Professions
| | | | - Qiang Chen
- Department of Psychiatric Rehabilitation and Counseling Professions
| | - Robin Eubanks
- Department of Psychiatric Rehabilitation and Counseling Professions
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29
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Williams TF, Powers AR, Ellman LM, Corlett PR, Strauss GP, Schiffman J, Waltz JA, Silverstein SM, Woods SW, Walker EF, Gold JM, Mittal VA. Three prominent self-report risk measures show unique and overlapping utility in characterizing those at clinical high-risk for psychosis. Schizophr Res 2022; 244:58-65. [PMID: 35597134 PMCID: PMC9829103 DOI: 10.1016/j.schres.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 01/12/2023]
Abstract
Self-report questionnaires have been developed to efficiently assess psychosis risk and vulnerability. Despite this, the validity of these questionnaires for assessing specific positive symptoms in those at clinical high risk for psychosis (CHR) is unclear. Positive symptoms have largely been treated as a uniform construct in this critical population and there have been no reports on the construct validity of questionnaires for assessing specific symptoms. The present study examined the convergent, discriminant, and criterion validity of the Launay Slade Hallucination Scale-Revised (LSHS-R), Prodromal Questionnaire-Brief (PQB), and Community Assessment of Psychic Experiences positive scale (CAPE-P) using a multimethod approach. CHR individuals (N = 71) and healthy controls (HC; N = 71) completed structured clinical interviews, self-report questionnaires, and neuropsychological tests. Questionnaire intercorrelations indicated strong convergent validity (i.e., all rs > .50); however, evidence for discriminant validity was more variable. In examining relations to interviewer-assessed psychosis symptoms, all questionnaires demonstrated evidence of criterion validity, though the PQB showed the strongest convergent correlations (e.g., r = .48 with total symptoms). In terms of discriminant validity for specific positive symptoms, results were again more variable. PQB subscales demonstrated limited specificity with positive symptoms, whereas CAPE-P subscales showed some specificity and the LSHS-R showed high specificity. In addition, when correlations with internalizing and externalizing symptoms were examined, only the PQB showed consistent significant correlations. These results are interpreted in terms of the strengths and limitations of each measure, their value for screening, and their potential utility for clarifying differences between specific positive symptoms.
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Affiliation(s)
- Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, 30602, USA
| | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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30
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Abstract
Schizophrenia is increasingly recognized as a systemic disease, characterized by dysregulation in multiple physiological systems (eg, neural, cardiovascular, endocrine). Many of these changes are observed as early as the first psychotic episode, and in people at high risk for the disorder. Expanding the search for biomarkers of schizophrenia beyond genes, blood, and brain may allow for inexpensive, noninvasive, and objective markers of diagnosis, phenotype, treatment response, and prognosis. Several anatomic and physiologic aspects of the eye have shown promise as biomarkers of brain health in a range of neurological disorders, and of heart, kidney, endocrine, and other impairments in other medical conditions. In schizophrenia, thinning and volume loss in retinal neural layers have been observed, and are associated with illness progression, brain volume loss, and cognitive impairment. Retinal microvascular changes have also been observed. Abnormal pupil responses and corneal nerve disintegration are related to aspects of brain function and structure in schizophrenia. In addition, studying the eye can inform about emerging cardiovascular, neuroinflammatory, and metabolic diseases in people with early psychosis, and about the causes of several of the visual changes observed in the disorder. Application of the methods of oculomics, or eye-based biomarkers of non-ophthalmological pathology, to the treatment and study of schizophrenia has the potential to provide tools for patient monitoring and data-driven prediction, as well as for clarifying pathophysiology and course of illness. Given their demonstrated utility in neuropsychiatry, we recommend greater adoption of these tools for schizophrenia research and patient care.
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Affiliation(s)
- Steven M Silverstein
- To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA; tel: +1 585-275-6742, e-mail:
| | - Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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31
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Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Both unmedicated and medicated individuals with schizophrenia show impairments across a wide array of cognitive and reinforcement learning tasks. Psychol Med 2022; 52:1115-1125. [PMID: 32799938 PMCID: PMC8095353 DOI: 10.1017/s003329172000286x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function. METHODS The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning. RESULTS Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks. CONCLUSIONS These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.
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Affiliation(s)
- Erin K. Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - James M. Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | - Steven M. Silverstein
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School Hospital, Piscataway, NJ
| | - Steven J. Luck
- Department of Psychology, University of California, Davis, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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Fradkin SI, Silverstein SM. Resistance to Depth Inversion Illusions: A Biosignature of Psychosis with Potential Utility for Monitoring Positive Symptom Emergence and Remission in Schizophrenia. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Green KM, Choi JJ, Ramchandran RS, Silverstein SM. OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment. Front Digit Health 2022; 4:836851. [PMID: 35252961 PMCID: PMC8894243 DOI: 10.3389/fdgth.2022.836851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
The human retina and retinal imaging technologies continue to increasingly gain the attention of schizophrenia researchers. With the same embryologic origin as the brain, the retina offers a window into neurovascular changes that may underlie disease. Recently, two technologies that have already revolutionized the field of ophthalmology, optical coherence tomography (OCT), and a functional extension of this, optical coherence tomography angiography (OCTA), have gained traction. Together, these non-invasive technologies allow for microscopic imaging of both structural and vascular features of the retina. With ease of use and no side effects, these devices are likely to prove powerful digital health tools in the study and treatment of schizophrenia. They may also prove key to discovering disease relevant biomarkers that underly neurodevelopmental and neurodegenerative aspects of conditions such as schizophrenia.
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Affiliation(s)
- Kyle M. Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
| | - Joy J. Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Rajeev S. Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Steven M. Silverstein
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Center for Visual Science, University of Rochester, Rochester, NY, United States
- *Correspondence: Steven M. Silverstein
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Keane BP, Erlikhman G, Serody M, Silverstein SM. A brief psychometric test reveals robust shape completion deficits in schizophrenia that are less severe in bipolar disorder. Schizophr Res 2022; 240:78-80. [PMID: 34974396 PMCID: PMC8917988 DOI: 10.1016/j.schres.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Brian P. Keane
- University Behavioral Health Care, Rutgers, The State University of New Jersey, 671 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester 14642, NY,Department of Neuroscience and Center for Visual Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA,Department of Brain and Cognitive Science, University of Rochester, 363 Meliora Hall, Rochester, NY 14627, USA
| | - Gennady Erlikhman
- UCLA Human Perception Laboratory and Psychology Department, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA
| | - Megan Serody
- University Behavioral Health Care, Rutgers, The State University of New Jersey, 671 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester 14642, NY
| | - Steven M. Silverstein
- University Behavioral Health Care, Rutgers, The State University of New Jersey, 671 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester 14642, NY,Department of Neuroscience and Center for Visual Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA,Department of Ophthalmology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
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Silverstein SM, Wang Y, Roché MW. Corrigendum: Base Rates, Blindness, and Schizophrenia. Front Psychol 2021; 12:732333. [PMID: 34621226 PMCID: PMC8491634 DOI: 10.3389/fpsyg.2021.732333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Steven M Silverstein
- University Behavioral HealthCare, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, United States.,Department of Psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, United States
| | - Yushi Wang
- University Behavioral HealthCare, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, United States
| | - Matthew W Roché
- University Behavioral HealthCare, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, United States
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Fradkin SI, Erickson MA, Silverstein SM. Measurement of the omitted-stimulus response within the retina. J Vis 2021. [DOI: 10.1167/jov.21.9.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nguyen QD, Anesi SD, Chexal S, Chu DS, Dayani PN, Leng T, Meleth AD, Sallam AA, Sheppard JD, Silverstein SM, Toyos M, Wang RC, Foster CS. Management of repository corticotropin injection therapy for non-infectious uveitis: a Delphi study. Acta Ophthalmol 2021; 99:669-678. [PMID: 33751822 PMCID: PMC10863995 DOI: 10.1111/aos.14702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Diagnosis and management of non-infectious uveitis (NIU), a major cause of blindness worldwide, are challenging. Corticosteroids, the cornerstone of therapy, are not appropriate for long-term use, and while non-biologic and biologic immunomodulators may be used for some patients, data on their efficacy and safety in this population are limited. Repository corticotropin injection (RCI), believed to affect uveitis by multiple mechanisms, has received regulatory approval for treatment of ophthalmic diseases including posterior uveitis, but is not widely used or discussed in guidelines for the management of uveitis and ocular inflammatory diseases. METHODS The index study employed a modified Delphi process with a panel of 14 US-based ophthalmologists. Consensus recommendations were developed through a series of three questionnaires. Panellists rated statements on a Likert scale from -5 (strongly disagree) to +5 (strongly agree). RESULTS The Delphi panel provided consensus recommendations on examinations and testing needed for diagnosis, treatment goals, and the use of corticosteroids, as well as the use of non-biologic and biologic immunomodulators. The panel reached consensus that RCI may be considered for posterior and pan-uveitis, and dosing should be individualized for each patient. Dose reduction/discontinuation should be considered for excessive RCI-related toxicity, hyperglycaemia and/or diabetic complications, excessive costs, or remission ≥ 2 years. Patients should be weaned from RCI if uveitis is stable and well controlled. Adverse events during RCI therapy can be managed by appropriate interventions, with dose reduction/discontinuation considered if events are severe or recurrent. CONCLUSIONS Expert consensus suggests RCI may be an appropriate treatment option for some patients with uveitis when other therapies are ineffective or intolerable.
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Affiliation(s)
- Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stephen D. Anesi
- Massachusetts Eye Research & Surgery Institution (MERSI), Waltham, MA, USA
| | | | - David S. Chu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
- Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ, USA
| | - Pouya N. Dayani
- Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA
| | - Theodore Leng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ahmed A. Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Jerotic S, Lalovic N, Pejovic S, Mihaljevic M, Pavlovic Z, Britvic D, Risimic D, Soldatovic I, Silverstein SM, Maric NP. Sex differences in macular thickness of the retina in patients with psychosis spectrum disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110280. [PMID: 33567332 DOI: 10.1016/j.pnpbp.2021.110280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Imaging of retinal structure in psychosis spectrum disorders (PSD) is a novel approach to studying effect of this illness class on CNS structure. Studies of optical coherence tomography (OCT) have revealed significant reductions in regarding: retinal nerve fiber layer (RNFL), macular thickness (MT), ganglion cell-inner plexiform layer (GC-IPL) and macular volume (MV). Sex differences in retinal structure in PSD have not been previously explored. METHODS This cross-sectional pilot study included 81 participant of age matched patients and controls. There were no differences between genders regarding illness duration and antipsychotic daily dose in the patient group. SD-OCT assessed RNFL, GC-IPL, MT, MV, and optic nerve cup-to-disc (C/D) ratio. In order to assess the main effects of illness, sex, and illness × sex interaction on the retinal parameters, general linear model was performed. RESULTS Patients demonstrated abnormalities on all OCT indices. Effects of sex were observed for central subfield MT and C/D ratio, which were lower in females. An illness × sex interaction effect was observed for the left MT, indicating greater thinning in female patients. CONCLUSION Sex differences in OCT findings in PSD appear to be most prominent considering macular parameters. These preliminary data may have important implications for the valid interpretation of OCT findings as potential biomarkers for PSD.
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Affiliation(s)
- Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.
| | - Nikola Lalovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Slobodanka Pejovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Mihaljevic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorana Pavlovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dubravka Britvic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dijana Risimic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Ophthalmology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
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Silverstein SM, Sörensen S, Sunkara A, Lai A, Fradkin SI, Ramchandran RS. Association of vision loss and depressive symptomatology in older adults assessed for ocular health in senior living facilities. Ophthalmic Physiol Opt 2021; 41:985-995. [PMID: 34382220 DOI: 10.1111/opo.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE People with vision loss are at increased risk for major depressive disorder (MDD) and subclinical depression. However, screening for depression is rarely done in eye care settings or among groups in the general population known to have vision disorders. METHODS We examined the prevalence of depression, using the Patient Health Questionnaire - 2 (PHQ-2), among a group of older adults (N = 204; mean age = 82.15) at two senior living facilities (SLFs) and determined the relationships between severity of depression and objective visual findings, visual function, beliefs about taking an active role in one's own eye care (i.e., patient activation) and level of social support. RESULTS Approximately 50% of the sample had impaired vision in at least one eye, and close to 30% of the sample obtained a score on the PHQ-2 indicating the likely presence of major depressive disorder. Visual testing findings were related to visual function (e.g., ability to read), but not to depression. Patient activation was also not significantly related to the level of depression. However, impaired visual functioning and less social support were both strong predictors of depression. These two variables and their interaction accounted for 17% of the total PHQ-2 score variance. CONCLUSIONS These data indicate the potential utility of screening for depression as part of vision care in populations likely to have significant vision loss. The findings also suggest that a comprehensive approach to depression prevention and/or reduction in SLF and similar populations may require interventions to address reduced visual functioning and methods to strengthen social networks.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Visual Science, University of Rochester, Rochester, New York, USA
| | - Silvia Sörensen
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Counseling and Human Development, Margaret Warner Graduate School of Education and Human Development, University of Rochester, Rochester, New York, USA.,Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA
| | - Anoop Sunkara
- Department of Economics, University of Notre Dame, Notre Dame, Indiana, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Samantha I Fradkin
- Department of Psychology, University of Rochester, Rochester, New York, USA
| | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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Silverstein SM, Lai A, Green KM, Crosta C, Fradkin SI, Ramchandran RS. Retinal Microvasculature in Schizophrenia. Eye Brain 2021; 13:205-217. [PMID: 34335068 PMCID: PMC8318708 DOI: 10.2147/eb.s317186] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Schizophrenia is associated with alterations in neural structure and function of the retina that are similar to changes seen in the retina and brain in multiple neurodegenerative disorders. Preliminary evidence suggests that retinal microvasculature may also be compromised in schizophrenia. The goal of this study was to determine, using optical coherence tomography angiography (OCTA), whether 1) schizophrenia is associated with alterations in retinal microvasculature density; and 2) microvasculature reductions are associated with retinal neural layer thinning and performance on a measure of verbal IQ. PATIENTS AND METHODS Twenty-eight outpatients with schizophrenia or schizoaffective disorder and 37 psychiatrically healthy control subjects completed OCT and OCTA exams, and the Wechsler Test of Adult Reading. RESULTS Schizophrenia patients were characterized by retinal microvasculature density reductions, and enlarged foveal avascular zones, in both eyes. These microvascular abnormalities were generally associated with thinning of retinal neural (macular and peripapillary nerve fiber layer) tissue (but the data were stronger for the left than the right eye) and lower scores on a proxy measure of verbal IQ. First- and later-episode patients did not differ significantly on OCTA findings. CONCLUSION The retinal microvasculature impairments seen in schizophrenia appear to be a biomarker of overall brain health, as is the case for multiple neurological conditions. Additional research is needed, however, to clarify contributions of social disadvantage and medical comorbidities to the findings.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Mittal VA, Ellman LM, Strauss GP, Walker EF, Corlett PR, Schiffman J, Woods SW, Powers AR, Silverstein SM, Waltz JA, Zinbarg R, Chen S, Williams T, Kenney J, Gold JM. Computerized Assessment of Psychosis Risk. J Psychiatr Brain Sci 2021; 6:e210011. [PMID: 34307899 PMCID: PMC8302046 DOI: 10.20900/jpbs.20210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early detection and intervention with young people at clinical high risk (CHR) for psychosis is critical for prevention efforts focused on altering the trajectory of psychosis. Early CHR research largely focused on validating clinical interviews for detecting at-risk individuals; however, this approach has limitations related to: (1) specificity (i.e., only 20% of CHR individuals convert to psychosis) and (2) the expertise and training needed to administer these interviews is limited. The purpose of our study is to develop the computerized assessment of psychosis risk (CAPR) battery, consisting of behavioral tasks that require minimal training to administer, can be administered online, and are tied to the neurobiological systems and computational mechanisms implicated in psychosis. The aims of our study are as follows: (1A) to develop a psychosis-risk calculator through the application of machine learning (ML) methods to the measures from the CAPR battery, (1B) evaluate group differences on the risk calculator score and test the hypothesis that the risk calculator score of the CHR group will differ from help-seeking and healthy controls, (1C) evaluate how baseline CAPR battery performance relates to symptomatic outcome two years later (i.e., conversion and symptomatic worsening). These aims will be explored in 500 CHR participants, 500 help-seeking individuals, and 500 healthy controls across the study sites. This project will provide a next-generation CHR battery, tied to illness mechanisms and powered by cutting-edge computational methods that can be used to facilitate the earliest possible detection of psychosis risk.
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Affiliation(s)
- Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | | | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA 92697, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Steven M. Silverstein
- Center for Visual Science, Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
- The Family Institute at Northwestern University, Evanston, IL 60208, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Trevor Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Joshua Kenney
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
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Silverstein SM, Thompson JL, Gold JM, Schiffman J, Waltz JA, Williams TF, Zinbarg RE, Mittal VA, Ellman LM, Strauss GP, Walker EF, Woods SW, Levin JA, Kafadar E, Kenney J, Smith D, Powers AR, Corlett PR. Increased face detection responses on the mooney faces test in people at clinical high risk for psychosis. NPJ Schizophr 2021; 7:26. [PMID: 34001909 PMCID: PMC8129098 DOI: 10.1038/s41537-021-00156-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023]
Abstract
Identifying state-sensitive measures of perceptual and cognitive processes implicated in psychosis may allow for objective, earlier, and better monitoring of changes in mental status that are predictive of an impending psychotic episode, relative to traditional self-report-based clinical measures. To determine whether a measure of visual perception that has demonstrated sensitivity to the clinical state of schizophrenia in multiple prior studies is sensitive to features of the at-risk mental state, we examined differences between young people identified as being at clinical high risk for psychosis (CHR; n = 37) and non-psychiatric matched controls (n = 29) on the Mooney Faces Test (MFT). On each trial of the MFT, participants report whether they perceive a face in a degraded face image. The CHR group reported perceiving a greater number of faces in both upright and inverted MFT stimuli. Consistent with prior work, males reported more faces on the MFT than females in both conditions. However, the finding of greater reported face perception among CHR subjects was robustly observed in the female CHR group relative to the female control group. Among male CHR participants, greater reported face perception was related to increased perceptual abnormalities. These preliminary results are consistent with a small but growing literature suggesting that heightened perceptual sensitivity may characterize individuals at increased clinical risk for psychosis. Further studies are needed to determine the contributions of specific perceptual, cognitive, and motivational mechanisms to the findings.
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Affiliation(s)
- Steven M. Silverstein
- grid.412750.50000 0004 1936 9166University of Rochester Medical Center, New York, NY USA
| | - Judy L. Thompson
- grid.412750.50000 0004 1936 9166University of Rochester Medical Center, New York, NY USA
| | - James M. Gold
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Jason Schiffman
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA ,grid.266093.80000 0001 0668 7243Present Address: University of California, Irvine, CA USA
| | - James A. Waltz
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Trevor F. Williams
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Richard E. Zinbarg
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Vijay A. Mittal
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Lauren M. Ellman
- grid.264727.20000 0001 2248 3398Temple University, Philadelphia, PA USA
| | | | - Elaine F. Walker
- grid.189967.80000 0001 0941 6502Emory University, Atlanta, GA USA
| | - Scott W. Woods
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Jason A. Levin
- grid.213876.90000 0004 1936 738XUniversity of Georgia, Athens, GA USA
| | - Eren Kafadar
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Joshua Kenney
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Dillon Smith
- grid.16750.350000 0001 2097 5006Princeton University, Princeton, NJ USA
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Pratt DN, Barch DM, Carter CS, Gold JM, Ragland JD, Silverstein SM, MacDonald AW. Reliability and Replicability of Implicit and Explicit Reinforcement Learning Paradigms in People With Psychotic Disorders. Schizophr Bull 2021; 47:731-739. [PMID: 33914891 PMCID: PMC8084427 DOI: 10.1093/schbul/sbaa165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Motivational deficits in people with psychosis may be a result of impairments in reinforcement learning (RL). Therefore, behavioral paradigms that can accurately measure these impairments and their change over time are essential. METHODS We examined the reliability and replicability of 2 RL paradigms (1 implicit and 1 explicit, each with positive and negative reinforcement components) given at 2 time points to healthy controls (n = 75), and people with bipolar disorder (n = 62), schizoaffective disorder (n = 60), and schizophrenia (n = 68). RESULTS Internal consistency was acceptable (mean α = 0.78 ± 0.15), but test-retest reliability was fair to low (mean intraclass correlation = 0.33 ± 0.25) for both implicit and explicit RL. There were no clear effects of practice for these tasks. Largely, performance on these tasks shows intact implicit and impaired explicit RL in psychosis. Symptom presentation did not relate to performance in any robust way. CONCLUSIONS Our findings replicate previous literature showing spared implicit RL and impaired explicit reinforcement in psychosis. This suggests typical basal ganglia dopamine release, but atypical recruitment of the orbitofrontal and dorsolateral prefrontal cortices. However, we found that these tasks have only fair to low test-retest reliability and thus may not be useful for assessing change over time in clinical trials.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Deanna M Barch
- Department of Psychology, Washington University, St. Louis, MO
| | - Cameron S Carter
- Department of Psychiatry, University of California at Davis, Davis, CA
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - John D Ragland
- Department of Psychiatry, University of California at Davis, Davis, CA
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Keane BP, Barch DM, Mill RD, Silverstein SM, Krekelberg B, Cole MW. Brain network mechanisms of visual shape completion. Neuroimage 2021; 236:118069. [PMID: 33878383 PMCID: PMC8456451 DOI: 10.1016/j.neuroimage.2021.118069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022] Open
Abstract
Visual shape completion recovers object shape, size, and number from spatially segregated edges. Despite being extensively investigated, the process’s underlying brain regions, networks, and functional connections are still not well understood. To shed light on the topic, we scanned (fMRI) healthy adults during rest and during a task in which they discriminated pac-man configurations that formed or failed to form completed shapes (illusory and fragmented condition, respectively). Task activation differences (illusory-fragmented), resting-state functional connectivity, and multivariate patterns were identified on the cortical surface using 360 predefined parcels and 12 functional networks composed of such parcels. Brain activity flow mapping (ActFlow) was used to evaluate the likely involvement of resting-state connections for shape completion. We identified 36 differentially-active parcels including a posterior temporal region, PH, whose activity was consistent across 95% of observers. Significant task regions primarily occupied the secondary visual network but also incorporated the frontoparietal dorsal attention, default mode, and cingulo-opercular networks. Each parcel’s task activation difference could be modeled via its resting-state connections with the remaining parcels (r=.62, p<10−9), suggesting that such connections undergird shape completion. Functional connections from the dorsal attention network were key in modelling task activation differences in the secondary visual network. Dorsal attention and frontoparietal connections could also model activations in the remaining networks. Taken together, these results suggest that shape completion relies upon a sparsely distributed but densely interconnected network coalition that is centered in the secondary visual network, coordinated by the dorsal attention network, and inclusive of at least three other networks.
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Affiliation(s)
- Brian P Keane
- University Behavioral Health Care, Department of Psychiatry, and Center for Cognitive Science, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA; Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Deanna M Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Ravi D Mill
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, 197 University Ave 07102, USA
| | - Steven M Silverstein
- University Behavioral Health Care, Department of Psychiatry, and Center for Cognitive Science, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA; Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Ophthalmology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
| | - Bart Krekelberg
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, 197 University Ave 07102, USA
| | - Michael W Cole
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, 197 University Ave 07102, USA
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45
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Beaudette DM, Gold JM, Waltz J, Thompson JL, Cherneski L, Martin V, Monteiro B, Cruz LN, Silverstein SM. Predicting Attention-Shaping Response in People With Schizophrenia. J Nerv Ment Dis 2021; 209:203-207. [PMID: 33315800 PMCID: PMC8516075 DOI: 10.1097/nmd.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT People with schizophrenia often experience attentional impairments that hinder learning during psychological interventions. Attention shaping is a behavioral technique that improves attentiveness in this population. Because reinforcement learning (RL) is thought to be the mechanism by which attention shaping operates, we investigated if preshaping RL performance predicted level of response to attention shaping in people with schizophrenia. Contrary to hypotheses, a steeper attentiveness growth curve was predicted by less intact pretreatment RL ability and lower baseline attentiveness, accounting for 59% of the variance. Moreover, baseline attentiveness accounted for over 13 times more variance in response to attention shaping than did RL ability. Results suggest attention shaping is most effective for lower-functioning patients, and those high in RL ability may already be close to ceiling in terms of their response to reinforcers. Attention shaping may not be a primarily RL-driven intervention, and other mechanisms of its effects should be considered.
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Affiliation(s)
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland, Catonsville, Maryland
| | - James Waltz
- Maryland Psychiatric Research Center, University of Maryland, Catonsville, Maryland
| | - Judy L Thompson
- Rutgers University, Behavioral Health Care, Piscataway Township, New Jersey
| | - Lindsay Cherneski
- Rutgers University, Behavioral Health Care, Piscataway Township, New Jersey
| | - Victoria Martin
- Rutgers University, Behavioral Health Care, Piscataway Township, New Jersey
| | - Brian Monteiro
- Rutgers University, Behavioral Health Care, Piscataway Township, New Jersey
| | - Lisa N Cruz
- Rutgers University, Behavioral Health Care, Piscataway Township, New Jersey
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY,Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY,Center for Visual Science, University of Rochester, Rochester, NY,To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, US; tel: 505-275-6742, fax: 585-276-2094, e-mail:
| | - Brian P Keane
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY,Center for Visual Science, University of Rochester, Rochester, NY
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Silverstein SM, Lai A. The Phenomenology and Neurobiology of Visual Distortions and Hallucinations in Schizophrenia: An Update. Front Psychiatry 2021; 12:684720. [PMID: 34177665 PMCID: PMC8226016 DOI: 10.3389/fpsyt.2021.684720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
Schizophrenia is characterized by visual distortions in ~60% of cases, and visual hallucinations (VH) in ~25-50% of cases, depending on the sample. These symptoms have received relatively little attention in the literature, perhaps due to the higher rate of auditory vs. visual hallucinations in psychotic disorders, which is the reverse of what is found in other neuropsychiatric conditions. Given the clinical significance of these perceptual disturbances, our aim is to help address this gap by updating and expanding upon prior reviews. Specifically, we: (1) present findings on the nature and frequency of VH and distortions in schizophrenia; (2) review proposed syndromes of VH in neuro-ophthalmology and neuropsychiatry, and discuss the extent to which these characterize VH in schizophrenia; (3) review potential cortical mechanisms of VH in schizophrenia; (4) review retinal changes that could contribute to VH in schizophrenia; (5) discuss relationships between findings from laboratory measures of visual processing and VH in schizophrenia; and (6) integrate findings across biological and psychological levels to propose an updated model of VH mechanisms, including how their content is determined, and how they may reflect vulnerabilities in the maintenance of a sense of self. In particular, we emphasize the potential role of alterations at multiple points in the visual pathway, including the retina, the roles of multiple neurotransmitters, and the role of a combination of disinhibited default mode network activity and enhanced state-related apical/contextual drive in determining the onset and content of VH. In short, our goal is to cast a fresh light on the under-studied symptoms of VH and visual distortions in schizophrenia for the purposes of informing future work on mechanisms and the development of targeted therapeutic interventions.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States.,Center for Visual Science, University of Rochester Medical Center, Rochester, NY, United States
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Thakkar KN, Ghermezi L, Silverstein SM, Slate R, Yao B, Achtyes ED, Brascamp JW. Stronger tilt aftereffects in persons with schizophrenia. J Abnorm Psychol 2020; 130:186-197. [PMID: 33301337 DOI: 10.1037/abn0000653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Individuals with schizophrenia may fail to appropriately use temporal context and apply past environmental regularities to the interpretation of incoming sensory information. Here we use the visual system as a test bed for investigating how prior experience shapes perception in individuals with schizophrenia. Specifically, we use visual aftereffects, illusory percepts resulting from prior exposure to visual input, to measure the influence of prior events on current processing. At a neural level, visual aftereffects arise due to attenuation in the responses of neurons that code the features of the prior stimulus (neuronal adaptation) and subsequent disinhibition of neurons signaling activity at the opposite end of the feature dimension. In the current study, we measured tilt aftereffects and negative afterimages, 2 types of aftereffects that reflect, respectively, adaptation of cortical orientation-coding neurons and adaptation of subcortical and retinal luminance-coding cells in persons with schizophrenia (PSZ; n = 36) and demographically matched healthy controls (HC; n = 22). We observed stronger tilt aftereffects in PSZ compared to HC, but no difference in negative afterimages. Stronger tilt aftereffects were related to more severe negative symptoms. These data suggest oversensitivity to recent regularities, in the form of stronger visual adaptation, at cortical, but not subcortical, levels in schizophrenia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Del Pozzo J, Cherneski L, Beck SJ, Lowe SR, Silverstein SM. Psychiatric Patients with a Serious Mental Illness and a Recent History of Violent Behavior: An Exploration of Developmental, Clinical, Cognitive, and Demographic Characteristics. CPRR 2020. [DOI: 10.2174/2666082216999200425222601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Epidemiologic studies have shown that persons suffering from psychotic
disorders are at increased risk of violent behavior. Several factors have been shown to predict violent
behavior among persons with psychosis. However, prior research is limited in that these factors
have not been explored simultaneously within the same study.
Methods:
The current study, therefore, aimed to determine which demographic, clinical, cognitive,
and developmental characteristics were associated with an increased likelihood of violence among
patients diagnosed with a psychotic disorder and which combination of these best predicted a history
of violence. Participants (n=53) completed measures of demographics, violence risk, psychotic
and personality symptoms, trauma, psychopathy and cognitive functioning.
Results:
Bivariate relationships were conducted to compare the history of violent behavior between
all variables. Additionally, a binary logistic regression was run predicting participants’ history of
violence. Several demographic, cognitive, clinical, and developmental factors were associated with
increased odds of having a history of violence. The overall correct classification rate for the model
was 92.2%, with 87.5% of participants without a history of violence and 91.4% with a history of
violence being correctly classified. The model included antisocial personality traits, poor behavioral
controls, head injury, not accepting responsibility, lacking goals, prior supervision failures, and
HCR-20 total score.
Conclusion:
The binary logistic regression model showed good accuracy in predicting a history of
violence in persons with psychosis. These findings are consistent with prior research and can inform
efforts at risk assessment and identification of treatment targets for people with a psychotic disorder
who are at highest risk of violence.
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Affiliation(s)
- Jill Del Pozzo
- Department of Psychology, Montclair State University, Montclair, NJ 07043, United States
| | - Lindsay Cherneski
- Division of Schizophrenia Research, University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, United States
| | - Saul J. Beck
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ 08854, United States
| | - Sarah R. Lowe
- Yale School of Public Health, Department of Social and Behavioral Sciences, Yale University, New Haven, CT 06520, United States
| | - Steven M. Silverstein
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, United States
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Abstract
Purpose An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. Patients and methods A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. Results Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. Conclusion In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.
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Affiliation(s)
- Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester, Rochester, NY, USA
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